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Objectives  Skull base chordomas are locally aggressive malignant tumors derived from the notochord remnant. There are limited large-scale studies examining the role and extent of surgery and radiation therapy. Design  Analysis of the National Cancer Database (NCDB) was performed to evaluate the survival outcomes of various treatments, and to assess for predictors of overall survival (OS). Participants  This is a retrospective, population-based cohort study of patients diagnosed with a clival/skull base chordoma between 2004 and 2015 in the NCDB. Main Outcome Measures  The primary outcome was overall survival (OS). Results  In all, 468 cases were identified. Forty-nine percent of patients received surgery and 20.7% had positive margins. Mean age at diagnosis was 48.4 years in the surgical cohort, and 55% were males. Of the surgical cohort, 33.8% had negative margins, 20.7% had positive margins, and 45.5% had unknown margin status. Age ≥ 65 (hazard ratio [HR]: 3.07; 95% confidence interval [CI]: 1.63-5.76; p  5 cm (HR: 2.29; 95% CI: 1.26-4.15; p  = 0.007), and government insurance (HR: 2.28; 95% CI: 1.24-4.2; p  = 0.008) were independent predictors of OS. When comparing surgery with or without adjuvant radiation, no survival differences were found, regardless of margin status ( p  = 0.66). Conclusion  Surgery remains the mainstay of therapy. Advanced age (>65 years), large tumor size, and government insurance were predictors of worse OS. Whereas negative margins and the use of adjuvant radiation did not appear to impact OS, these may very well reduce local recurrences. A multidisciplinary approach is critical in achieving optimal outcomes in this challenging disease.

Objectives/hypothesisThis study utilizes a large population national database to comprehensively analyze prognosticators and overall survival (OS) outcomes of varying treatment modalities in a large cohort of sinonasal diffuse large B-cell lymphoma (SN-DLBCL) patients.Study designRetrospective database study.MethodsThe National Cancer Database was queried for all SN-DLBCL cases diagnosed from 2004 to 2015. Kaplan-Meier log-rank test determined differences in OS based on clinical covariates. Cox proportional-hazards analysis was used to determine clinical and sociodemographic covariates predictive of mortality.ResultsA total of 2,073 SN-DLBCL patients were included, consisting of 48% female with a mean age of 66.0 ± 16.2 years. Overall, 82% of patients were Caucasian, 74% had early-stage disease, and 49% had primary tumors in the paranasal sinuses. Early-stage patients were more likely to receive multi-agent chemoradiotherapy compared to multi-agent chemotherapy alone (P

BackgroundNo study to date has analyzed the progression of sinonasal symptoms over time in COVID-19 patients. The purpose of this study is to analyze the progression of sinonasal symptoms and risk factors for olfactory dysfunction in the mild severity COVID-19 patient.MethodsAn internet survey was used to assess sinonasal symptoms in patients with COVID-19. Changes in rhinologic domain and symptom-specific Sinonasal Outcome Test (SNOT-22) scores were compared at five time points: two weeks before diagnosis, at diagnosis, two weeks after diagnosis, four weeks after diagnosis, and six months after diagnosis.Results521 responses were collected. Rhinologic domain SNOT-22 scores increased significantly (p  0.999). Taste-specific SNOT-22 scores also peaked at diagnosis (2.06, p  0.999). There were no significant differences in sense of smell or taste between 1-month and 6-month timepoints.ConclusionSinonasal symptoms, particularly loss of smell and taste, may be important presenting symptoms in the mild severity COVID-19 patient. Our findings support incorporating these symptoms into screening protocols.Level of evidence4.

IntroductionThe emergence of popular online rating websites, social media platforms, and public databases for industry payments and scholarly outputs provide a complete physician online presence which may guide choice and satisfaction.MethodsWebsites of all U.S. otolaryngology academic institutions were queried for fellowship-trained rhinologists. Additional well-known and academically active rhinologists were identified by the senior author. Online ratings and comments were collected from Google, Healthgrades, Vitals, and RateMD websites, and weighted rating scores (RS) were calculated on a 1-5 scale.ResultsA total of 210 rhinologists with 16 ± 9 years of practice were included, where 6901 online ratings (33 ± 47 per rhinologist) provided an average RS of 4.3 ± 0.6. RS was not different according to gender (p = 0.58), geographic quartile (p = 0.48), social media presence (p = 0.41), or attending top-ranked medical school (p = 0.86) or residency programs (p = 0.89). Years of practice negatively correlated with RS (R = -0.22, p$300 (n = 113). Attending a top-ranked medical school was associated with higher industry payments (p

BackgroundRecently, there has been mounting evidence suggesting the efficacy of steroid-eluting stents (SES) for management of chronic rhinosinusitis after endoscopic sinus surgery (ESS). This meta-analysis serves to evaluate the efficacy of SES in improving postoperative outcomes after ESS.MethodsA systematic literature search was performed of PubMed for articles published between 1985 and 2018. The outcome variables were reported at, on average, 30 days postintervention.ResultsSeven of the 76 published studies, all of which were industry-sponsored, were included for a collective cohort of 444 SES and 444 control sinuses. In patients who received SES vs controls, collective odds ratios (ORs) for postoperative need for intervention, surgery, and oral steroid were 0.45 (95% confidence interval [CI], 0.33-0.62; p < 0.001), 0.30 (95% CI, 0.18-0.52; p < 0.001), and 0.58 (95% CI, 0.40-0.84; p = 0.004), respectively. In addition, collective ORs for frontal sinus ostia (FSO) patency, moderate-to-severe adhesion/scarring, and increase in polyp score were 2.53 (95% CI, 1.61-3.97; p < 0.001), 0.28 (95% CI, 0.13-0.59; p < 0.001), and 0.42 (95% CI, 0.25-0.74; p = 0.002), respectively. Collective mean differences for FSO/ethmoid inflammation and FSO diameter were -10.86 mm (p < 0.001) and +1.34 mm (p < 0.001), respectively.ConclusionAggregate evidence suggests that SES can improve ESS outcomes by reducing rates of postoperative intervention and recurrent polyposis and inflammation, while promoting FSO patency. All included and analyzed studies were industry-sponsored and ruling-out publication bias was not possible. Future independent and nonsponsored studies to further evaluate SES's long-term efficacy are warranted.

BackgroundEsthesioneuroblastoma (ENB), also known as olfactory neuroblastoma, represents up to 3% of all sinonasal neoplasms. Hyams histologic grading is a promising tool in predicting metastases and establishing prognoses for this complex tumor.MethodsA systematic literature search was performed in the PubMed, Ovid MEDLINE, and Cochrane databases. ENB patients with Hyams I-II or III-IV were categorized as low-grade Hyams (LGH) or high-grade Hyams (HGH), respectively. Binary and continuous random-effects models were applied to calculate odds ratios (ORs) for the incidences of neck and distal metastases as well as for 5- and 10-year overall survival rates.ResultsOf the 57 screened articles published from 1993 to 2018, 16 (525 patients) and 21 (563 patients) provided data for tumor metastases and overall survival rates, respectively. Neck metastasis was observed in 18.2% of HGH vs 7.9% of LGH patients. Distant metastasis was noted in 20.7% of HGH vs 8.9% of LGH patients. LGH patients had 5- and 10-year overall survival rates of 81.2% and 64.0%, respectively, as compared with 60.9% and 40.6%, respectively, for HGH patients. In comparing HGHs vs LGHs, the collective ORs for neck and distant metastases were 2.08 (95% confidence interval [CI], 1.09-3.99; p = 0.03) and 2.37 (95% CI, 1.07-5.26; p = 0.03), respectively. Moreover, in comparing LGHs vs HGHs, collective ORs for 5- and 10-year overall survival rates were 3.39 (95% CI, 2.09-5.49; p < 0.001) and 3.03 (95% CI, 1.82-5.06; p < 0.001), respectively.ConclusionHGH ENBs, compared with LGH ENBs, are more likely to metastasize to neck or distal targets and to have lower overall survival rates.

Background  Outcome studies on sinonasal malignancy are limited to retrospective case series, often with inclusion of diverse histology and short follow-up. The objective of this study was to identify key predictive variables that independently impact survival for paranasal sinus squamous cell carcinoma (SCC) and adenocarcinoma (AC) and to compare these variables in the context of these two distinct clinicopathologic entities. Methods:  Analysis was conducted using the Surveillance, Epidemiology, and End Results database from 1973 to 2012 to identify key variables that impact survival for SCC and AC. Results  A total of 3,714 cases were included. There were 2,895 SCC cases and 819 AC cases. The mean age at diagnosis was 64.1 years. The male to female ratio for SCC and AC was 1.85 and 1.04, respectively. Patients with SCC and AC were most often diagnosed with stage IV disease in 61.8 and 63.4% of cases, respectively. The majority of patients received combined surgery and radiation (52% for SCC and 43.1% for AC). For SCC, increased age ( p

Objectives: Endoscopic medial maxillectomy (EMM) is an effective intervention for patients with recalcitrant maxillary sinusitis after previous middle meatal antrostomy. The pathophysiology of refractory maxillary sinusitis is incompletely understood. We aim to identify trends in structured histopathology (SHP) to better understand how tissue architecture changes contribute to refractory sinusitis and impaired mucociliary clearance. Methods: All patients who underwent EMM or standard maxillary antrostomy for recalcitrant maxillary sinusitis of various forms were included. Retrospective chart review was conducted to collect information on demographics, disease characteristics, comorbid conditions, culture data, and SHP reports. Chi‐squared and logistic regression analyses were performed for SHP variables. Results: Forty‐one patients who underwent EMM and 464 patients who underwent maxillary antrostomy were included. On average, the EMM cohort was 10 years older (60.9 years vs. 51.1 years; p = 0.001) and more often had a history of prior sinus procedures (73.2% vs. 40.9%; p < 0.001). EMM patients had higher rates of fibrosis (34.1% vs. 15.1%, p = 0.002), and this remained statistically significant when controlling for prior sinus procedures and nasal polyposis (p = 0.001). Cultures positive for pseudomonas aeruginosa (38.2% vs. 5.6%, p < 0.001) and coagulase negative staphylococcus (47.1% vs. 23.5%, p = 0.003) were more prevalent in the EMM group. Conclusion: Fibrosis and bacterial infections with Pseudomonas and coagulase negative Staphylococcus were more prevalent in patients requiring EMM. This may contribute to the multifactorial etiology of impaired mucociliary clearance in patients with recalcitrant maxillary sinusitis. Level of Evidence: 3 Laryngoscope, 134:2646–2652, 2024 [ABSTRACT FROM AUTHOR]

Objective: Structured histopathology (SHP) is a method of analyzing sinonasal tissue to characterize endotypes of chronic rhinosinusitis with nasal polyps (CRSwNP). Allergic fungal rhinosinusitis (AFRS) shares several features with certain endotypes of CRSwNP. Our objective was to compare the histopathology of AFRS and eosinophilic CRSwNP to further understand whether they are separate endotypes or disease entities altogether. Methods: A retrospective review of AFRS and CRSwNP patients undergoing endoscopic sinus surgery was performed. Data were collected on demographics, comorbidities, subjective and objective severity scores, and 13‐variable SHP reports. CRSwNP patients with >10 eosinophils per high‐power field (eCRSwNP) were included. Chi‐squared and t‐tests were used for statistical analysis. Results: A total of 29 AFRS and 108 eCRSwNP patients were identified. AFRS patients were younger and more often Black. Symptom severity scores (SNOT‐22, Lund‐MacKay, and Lund‐Kennedy) were uniform between groups. AFRS patients had a higher rate of Charcot–Leyden crystals (41.4% vs. 10.2%; p < 0.001). Severe degree of inflammation, eosinophilic inflammatory predominance, eosinophil aggregates, subepithelial edema, and basement membrane thickening were common in both groups, and their rates were not statistically significantly different between groups. Metaplasia, ulceration, fibrosis, and hyperplastic/papillary change rates were low (<30%) and similar between groups. Conclusion: The SHP of eCRSwNP and AFRS are highly consistent, which suggests AFRS is a severe subtype of CRSwNP overall rather than a separate disease entity. This also lends credence to AFRS belonging on the endotypic spectrum of CRSwNP. Level of Evidence: 3 Laryngoscope, 134:2617–2621, 2024 [ABSTRACT FROM AUTHOR]

Background An ectopic pituitary adenoma presenting as a clival or sphenoid mass is a rare clinical occurrence that may mislead the clinician and result in unnecessary interventions or potential medicolegal consequences. Here, we present one of the largest multi-institutional case series and review the literature with an emphasis on radiological findings and critical preoperative workup. Methods Retrospective chart review. Results Nine patients were identified with ectopic pituitary adenomas of the sphenoid or clivus. There were four females and five males. Median age was 60 years old (range, 36-73 years). The most common presenting symptom was headache (56%). Five (56%) patients presented with a mass arising from the clivus while four (44%) presented with a mass in the sphenoid. Six (67%) patients demonstrated biochemical evidence of hypersecretion on full endocrinology panel. All masses showed evidence of enhancement with gadolinium with a propensity for adjacent bone involvement. Lesions also had a predilection for growth toward the cavernous sinus, carotid artery, or sellar floor. Surgical intervention was performed in eight patients (89%). In eight patients (89%), tumors demonstrated immunoreactivity to prolactin. Conclusions Pituitary adenomas can rarely present as an isolated sphenoid or clival mass. Lesions displayed similar magnetic resonance imaging findings with an erosive growth pattern toward the sellar floor, cavernous sinus, or adjacent carotid artery. Patients with clival or parasellar lesions with comparable features should have a preoperative workup which includes prolactin level and alert the physician to consider an ectopic pituitary adenoma in the differential to prevent unnecessary surgery and potential complications.

BACKGROUND: There is preliminary evidence that patients with chronic rhinosinusitis (CRS) and comorbid obstructive sleep apnea (OSA) have reduced quality-of-life (QOL) improvements after functional endoscopic sinus surgery (FESS) compared with patients without OSA. The effect of OSA severity on QOL improvement after FESS is unknown. OBJECTIVES: To better characterize the QOL improvement after FESS for patients with comorbid OSA and to assess whether QOL improvement is dependent on OSA severity. METHODS: This multi-institution, retrospective cohort study evaluated adult patients with CRS who underwent FESS between 2007 and 2015. Preoperative, 1-month, 3-month, 6-month, and 1-year postoperative 22-Item Sino-Nasal Outcome Test scores were used to evaluate QOL. We compared patients without OSA with patients with stratified OSA based on the preoperative apnea-hypopnea index. A multilevel, mixed-effects linear regression model was used for the analysis. RESULTS: Of 480 participants, 83 (17%) had OSA, and 47 of these patients had polysomnography results available for review. Both patients with OSA and patients without OSA reported significant QOL improvement after surgery (p < 0.0001) relative to baseline. In the unadjusted model, the subjects with OSA demonstrated a statistically worse outcome in 22-Item Sino-Nasal Outcome Test scores at each time point (2.4 points higher per time point, p = 0.006). When controlling for covariates, the adjusted model showed no difference in QOL outcome based on OSA status (p = 0.114). When stratified by OSA disease severity, the adjusted model showed no difference in the QOL outcome. CONCLUSIONS: Patients with CRS and comorbid OSA had worse QOL outcomes after FESS; however, when controlling for patient factors, there was no difference in QOL outcome. OSA disease severity did not seem to predict QOL improvement after FESS.

Objective: To analyze clinical and radiographic features that may impact the rate of focal hyperostosis (FH) on computed tomography (CT) for primary and recurrent sinonasal inverted papillomas (IPs) as well as highlight factors that may affect concordance between FH and IP true attachment point (TAP). Methods: All IPs resected between 2006 and 2022 were retrospectively reviewed. CTs were read by a neuroradiologist blinded to operative details. IP with malignancy was excluded. Operative reports and long‐term follow‐up data were evaluated. Results: Of 92 IPs, 60.1% had FH, 25% had no CT bony changes, and 20.7% were revision cases. The recurrence rate for rhinologists was 10.5% overall and 7.3% for primary IPs. Primary and revision IPs had a similar rate of FH (63% vs. 52.6%; p = 0.646) and FH–TAP agreement (71.7% vs. 90%; p = 0.664). Nasal cavity IPs, especially with septal attachment, were more likely to lack bony changes on CT (57.1%) compared to other subsites (p = 0.018). Recurrent tumors were 16 mm larger on average (55 mm vs. 39 mm; p = 0.008). FH (75.0% vs. 60.9%; p = 0.295), FH–TAP concordance (91.7% vs. 74.4%; p = 0.094), and secondary IP (18.8% vs. 20.3%; p = 0.889) rates were similar between recurrent and nonrecurrent tumors. Conclusion: Primary and revision IPs have a similar rate of FH and FH–TAP agreement. Nasal cavity IPs are less likely to exhibit bony CT changes. Lower recurrence was associated with smaller size and fellowship training but not multiple TAPs, revision, FH absence, or FH–TAP discordance. Level of Evidence: 3 Laryngoscope, 134:1591–1596, 2024 [ABSTRACT FROM AUTHOR]

Isolated primary sphenoid sinusitis is a rare occurrence, estimated to make up less than 3% of sinus infections. The posterior anatomic location of the sphenoid makes treatment challenging when it becomes infected. Complications involving intracranial extension to surrounding structures often result in cranial nerve deficits due to their proximity. A single case of chronic sphenoiditis with direct extracranial extension into the prevertebral space is reported with a discussion on clinical presentation, diagnosis, and management. A 46-year-old female patient with diffuse headaches radiating into the neck and throat was evaluated in the office. Computed tomography demonstrated sphenoiditis with direct extension into the prevertebral space. Imaging revealed a purported route of direct extension through the clinoid and directly into the clivus to form an abscess in the longus colli muscle. The patient underwent endoscopic surgical management including drainage of the prevertebral abscess and has since made a full recovery. This is the first reported case of direct extension of sphenoiditis into the prevertebral space. The findings highlight the importance of aggressive treatment of chronic sphenoid infections to prevent detrimental complications. Computed tomography imaging proved an advantageous imaging modality to demonstrate bony erosion and sinus tracts from the skull base to the deep neck space. [ABSTRACT FROM AUTHOR]

This article discusses a case series involving the treatment of complex skull base lesions using a combined endoscopic and open cranial approach. The study included 9 patients with various pathologies, such as sinonasal undifferentiated carcinoma, esthesioneuroblastoma, meningioma, mucormycosis, and skull base defect/encephalocele. The surgical goal of achieving gross total tumor resection, resolution of infection, and skull base resection/repair was achieved in 8 out of 9 cases. The study concludes that concurrent combined approaches can effectively treat complex and recurrent skull base pathologies in select patients. [Extracted from the article]

IntroductionSeptoplasty, or surgical correction of the deviated septum, is an elective, routinely performed rhinologic procedure to address nasal airway obstruction. In many cases, resected septal cartilage and bone fragments are sent for pathologic review, although there is no consensus on this practice. We reported two cases of incidentally diagnosed lymphoma after elective septoplasty and discussed clinical presentation, diagnosis, and management.MethodsRetrospective chart review of two patients who underwent septoplasty at a tertiary academic medical center and found to have incidental lymphoma based on histopathology.ResultsTwo patients who underwent septoplasty had an incidental diagnosis of lymphoma on pathologic analysis. One patient was noted to have an S-shaped septal deviation that produced bilateral nasal obstruction. She underwent a difficult septoplasty, in which the mucoperichondrial flap was firmly adherent to the underlying septum and bone. Final pathology demonstrated diffuse large B-cell lymphoma. She was treated with chemoradiation and remained free of disease at 59 months. The other patient had a history of nasal trauma, which produced left septal deviation. He underwent an uncomplicated septoplasty, with pathology that demonstrated low-grade B-cell lymphoma. Because there was no evidence of active disease, the decision was made to not treat and to observe the patient clinically.ConclusionsThis is the first reported series of septal lymphoma incidentally diagnosed on routine septoplasty. Although histopathologic review of specimens from routine nasal and sinus surgery is not routinely performed, this report highlighted the importance of this process, on a case-by-case basis, in detecting unexpected malignancies that otherwise were clinically silent.

Objectives To profile the clinical presentation and treatment results of esthesioneuroblastomas at the University of California, Los Angeles (UCLA), from 2002 to 2013. Design Retrospective review. Setting Tertiary academic institution. Participants Forty-one patients with esthesioneuroblastomas treated at UCLA. Main Outcome Measures Overall survival (OS) and recurrence-free survival (RFS). Results Thirty-six patients were included with a mean age of 50.1 years and a median duration of follow-up of 33 months. The 5-year RFS and OS were 54% and 82%, respectively. Modified Kadish stage was the only factor identified to affect OS. Multivariate analysis demonstrated that tumor grade was the only factor that had an independent impact on RFS. There was no statistical difference in survival among the surgical approaches chosen. Conclusions The updated data on the UCLA experience reveals that all three surgical approaches chosen provide comparable survival, although longer follow-up will be needed to ascertain if these findings hold true. The endoscopic approach had a statistically significant decrease in length of hospital stay and a trend toward reduced blood loss, intensive care unit admission, and complications. The modified Kadish staging was the only factor identified to predict OS. Multivariate analysis revealed that tumor grade was an independent predictor of recurrence; therefore, its importance should be emphasized in future staging systems.

Objective To review our experience in a series of patients who underwent revision endoscopic pituitary surgery. Methods Retrospective chart review. Results A total of 27 patients were included in the study. Of the 21 patients who required nasoseptal flap reconstruction, a left-sided nasoseptal flap was successfully used in 13 patients. Gross total or near-total resection of tumor was achieved in 74.1%. Cavernous sinus invasion and presentation with residual disease were identified as factors limiting extent of resection (p = 0.002 and 0.009, respectively). A statistically significant difference (p = 0.027) was noted between mean largest tumor dimension in patients with gross total resection and those with near-total or subtotal resection. Complications occurred in 22% and included postoperative temporary diabetes insipidus (n = 2), postoperative hypotension (n = 2), new anterior pituitary insufficiency (n = 1), and right-sided abducens palsy (n = 1). Conclusions Revision endoscopic pituitary surgery is advantageous but technically challenging. Cavernous sinus invasion and presentation with residual disease were significant factors limiting extent of resection. Suprasellar extension was not a factor limiting extent of resection and may prove to be an advantage over microscopic speculum-based approaches. Because of the right-sided scarring from prior surgery, a left-sided nasoseptal flap is reliable and advantageous.

PurposeTo profile the clinical presentation, subtype distribution, and treatment results of sarcomas of the head and neck at a single tertiary academic center over an 11-year period.Materials and methodsA retrospective review was performed by examining the records and reviewing the pathology of 186 patients with head and neck sarcomas treated at UCLA Medical Center from 2000 to 2011.ResultsThe mean age of the study population was 49 ± 22 years. 58% of the patients were male and 42% were female. Median duration of follow-up for the entire group was 18.5 months. The most common presenting symptom was a mass lesion in 59.9% of patients. The nasal cavity/sinus was the most common presenting site seen in 22% of patients. Solitary fibrous tumor/hemangiopericytoma was the most common subtype. 15% of patients had evidence of prior radiation exposure. 26.3% of tumors were greater than 5 cm and 35.5% were high-grade. Margins were positive in 31.2% of patients. Lymph node metastasis was rare at 6.5%. Perineural invasion was identified in 6.5%. Among all subtypes, 5-year recurrence-free survival and overall survival were 50% and 49%, respectively. Multivariate analysis demonstrated that grade and margin status were predictors of recurrence-free survival while grade and age affected overall survival.ConclusionsHead and neck sarcomas are a rare entity frequently presenting as a mass lesion. In our series, lesions tended to be high-grade with a significant portion of surgical specimens having positive margins. Grade and margin status were the most important predictors of survival.

Background: We aim to describe outcomes of elderly patients undergoing salvage surgery for laryngeal cancer and to characterize the interplay of age with various other factors in this growing population. Methods: Using the National Cancer Database, we identified cases of salvage laryngectomy in patients who failed chemoradiation. An age cutoff of 70 years was used to separate subjects into two groups. Various factors were compared. Results: Of the 825 patients included, 166 (20.1%) were elderly. Elderly patients had worse overall survival (p = 0.001), higher 30‐day and 90‐day mortality (p = 0.006, p < 0.001), and a longer length of stay (LOS) (p = 0.015). LOS over 1 week was associated with worse survival (p = 0.032). Conclusion: Elderly patients had worse overall perioperative survival than their younger counterparts. LOS and 30‐day readmissions were associated with higher risk of mortality in this group. We provide a contemporary set of relevant information for head and neck cancer providers to consider in this growing population [ABSTRACT FROM AUTHOR]

Metastatic skull base malignancies infrequently occur but, when present, typically arise from breast malignancies. Pterygopalatine fossa (PPF) metastasis of any malignancy is further seldom reported, and metastasis of gynecologic malignancies to the PPF has not been previously described in the literature. We present a single case of a 42-year-old female with the first likely case of high-grade endometrial sarcoma metastatic to the PPF. The patient presented with facial pain and numbness in the V2 distribution presented for evaluation. History was significant for several months of dysmenorrhea and metrorrhagia. Computed tomography, magnetic resonance imaging, and positron emission tomography imaging revealed a PPF mass with local extension and bony metastases. Endoscopic biopsy was performed, and final pathology was most consistent with metastatic high-grade endometrial stromal sarcoma. This is the first reported case of likely metastatic endometrial sarcoma to the PPF. This case report highlights the possibility of rare distant metastasis of gynecologic malignancy to this area of the skull base. [ABSTRACT FROM AUTHOR]